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Images in Neurology |

“Blinding” Empty Sella Can Lumbar Puncture Be Avoided?

Paolo Frassanito, MD; Pasquale De Bonis, MD; Carmela Grazia Caputo, MD; Annunziato Mangiola, MD; Angelo Pompucci, MD; Carlotta Ginevra Nucci, MD; Gianluca Trevisi, MD; Carmelo Anile, MD
Arch Neurol. 2012;69(7):932-933. doi:10.1001/archneurol.2011.2137.
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Primary empty sella syndrome is an anatomicoclinical condition characterized by radiological evidence of sellar arachnoidocele (unrelated to previous surgical or radiotherapeutic treatment of this region) and is associated with endocrine disturbances and signs of intracranial hypertension (headache, visual disturbances, and papilledema), especially in young women.1 We report on an unusual case of empty sella disguising the diagnosis of an ocular inflammatory disease.

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Figure. A, Sagittal T1-weighted magnetic resonance imaging scan with gadolinium enhancement revealing a large arachnoidocele in the sella turcica (arrow) that is pushing down on the sellar floor the pituitary gland and stretching the pituitary stalk. B, On the ultrasonographic A-scan, a maximally wide defect representing the lower reflective optic nerve in between steeply rising or falling surface spikes (corresponding to the lateral and nasal arachnoid surfaces of the optic nerve sheaths) indicates the maximum diameter of the optic nerve (distance) in the area scanned by the beam. C, The longitudinal ultrasonographic section (B-scan) rules out papilledema (arrow) and shows macular retinal serous detachment (arrowheads) and diffuse thickening of the choroidal layer (asterisk). The diffuse vascular leakage that is shown in the fluorescein angiographic scan (D, arrow), which is associated with the subretinal serous collection shown in the optical coherence tomographic scan (E, double asterisk), confirms the diagnosis of choroiditis. OD indicates oculus dexter.

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